Yanking the Cure Rug Out From Under Lymphoma Patients

In the continuing saga of two “miracle” drugs for those who suffer from non-Hodgkins lymphomas… the fifth most common cancer….

I told you six months ago about Bexxar and Zevalin, the two drugs which can treat non-Hodgkins lymphoma but were not being promoted by oncologists in private practice because they cannot, by law, administer it. That means they cannot profit by it. Remembering that American Healthcare is not about health or care, it’s about sickness and money…. we learned then that these drugs must be administered in (usually academic) medical centers because they have a radioactive component to them. So many oncologists provide infusion services themselves, but are not allowed to administer these two drugs, so they don’t tell their patients about them. I remain angry about that subject.

As if that weren’t difficult enough, there is now a new twist to this story, making it even more difficult for lymphoma patients to get this treatment they need — and deserve to have. According to the New York Times, Medicare has decided to reimburse administration of this drug in 2008 at about half the cost of the drug. Medicare made that determination, it says, based on what hospitals have been billing Medicare for the drug — but hospitals dispute that, saying they would never request reimbursement that would cost them almost $10,000 per patient! Patients need only one treatment, but it’s very expensive because the drug itself is very expensive.

Both hospitals and the manufacturers are confused as to how Medicare put together its reimbursement schedule. They believe errors have been made, and that Medicare’s numbers are wrong.

So here’s how this begins to domino….

Since the reimbursements won’t even cover the cost of the drug, hospitals will stop treating Medicare patients with it. (can you blame them? would you offer a service that put you $10,000 in the red each time you did it?)

By law, if a treatment is not offered to Medicare patients, it cannot be offered to any other patient by that same provider.

If there is no way the drug can be administered, then, of course, it won’t be sold by the manufacturer. That means the manufacturer then loses money on the cost of researching and developing such a drug — which means they lose incentive to research and develop new drugs.

Meaning — because lymphoma patients will not be able to be treated by this life-saving drug, then other patients with other diseases may someday suffer, too.

There needs to be some kind of compromise here and hopefully Medicare will work out the kinks in their adding machines. People are sick. A promising drug is available. And their own government is telling them they can’t have it.